Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke

Jung, Sung Eun; Jung, Cheolkyu; Kim, Jae Hyoung; Choi, Byung Se; Bae, Yun Jung; Sunwoo, Leonard; Woo, Ho Geol; Chang, Joon-Hyuk; Kim, Beom Joon; Han, Moon Ku; Bae, Hee Joon

doi:10.1177/1591019918776207

Cited by 47 publications

(72 citation statements)

References 21 publications

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“…All patients who had undergone chemotherapy had received at least one thrombogenic agent, which may have increased the risk of stroke [4]. Functional outcome measures showed a significant improvement after thrombectomy, in line with previous reports [13,14]. Patient characteristics including site of thrombus and cardiovascular risk profile (Tables 1 and S1) were comparable to those from a recent prospective trial in patients not stratified for cancer [15].…”

Section: Discussionsupporting

confidence: 82%

Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion

Wolpert

Kulcsár

Hänsel

et al. 2020

Euro J of Neurology

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Background and purpose Stroke is a dreaded complication in patients with cancer. Besides paraneoplastic coagulopathy, chemotherapy, radiotherapy and tumor‐directed invasive procedures, circulating cancer cells may contribute to thrombus formation and embolic stroke. However, the incidence of tumor cells within the blood clots of cancer patients with stroke is unknown and the role of circulating tumor cells in the formation of cerebrovascular thrombi remains unclear. Methods All patients who had undergone cerebrovascular thrombectomy at the University Hospital Zurich between 2014 and 2017 were screened for history of cancer. Clinical information was retrieved from the local stroke registry and the electronic charts and thrombi underwent a thorough histopathological re‐review. Results Thirty‐two of 182 patients (18%) with thrombectomy had a history of cancer. The majority of patients had advanced stage cancer. However, even after extensive histopathological re‐review, only one specimen revealed tumor cells in the thrombus: a 75‐year‐old patient with acute occlusion of the middle cerebral artery who had been diagnosed with non‐small‐cell lung cancer 8.1 months prior to stroke. Conclusions The presence of cancer cells in clots from cerebrovascular thrombectomy, indicative of a direct involvement of circulating tumor cells in the causation of stroke, is rare.

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Section: Discussionsupporting

confidence: 82%

Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion

Wolpert

Kulcsár

Hänsel

et al. 2020

Euro J of Neurology

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“…This is probably because ischemic stroke frequently occurs at the late stage of malignancy when the condition of the patients is not as good as that of the participants in clinical trials ( 3 ). Short-term prognosis for patients who underwent EVT with concomitant malignancy has been reported by others, and the results were mostly similar ( Table 3 ) ( 21 , 22 ). Jung et al showed the result of EVT for 19 patients with active cancer and reported that only three patients (16%) were able to attain functional independence, while the rest were either bedridden (4 patients; 21%) or died (12 patients; 63%) ( 21 ).…”

Section: Discussionsupporting

confidence: 81%

“…Short-term prognosis for patients who underwent EVT with concomitant malignancy has been reported by others, and the results were mostly similar ( Table 3 ) ( 21 , 22 ). Jung et al showed the result of EVT for 19 patients with active cancer and reported that only three patients (16%) were able to attain functional independence, while the rest were either bedridden (4 patients; 21%) or died (12 patients; 63%) ( 21 ). Sallustio et al showed that functional independence was achieved in 42% of the patients, while they noticed a mortality rate of 29% ( 22 ).…”

Section: Discussionsupporting

confidence: 81%

“…Prestroke mRS score was 0 for nine patients, 2 for one patient, and 3 for two patients. NIHSS score at admission was 17.2 [interquartile range (IQR), [14][15][16][17][18][19][20][21] and ASPECTS ranged from 8 to 10. The location of atrial occlusions was determined at the internal cerebral artery (ICA) (n = 2), proximal portion of the middle cerebral artery (MCA) (M1; n = 8), and middle portion of the MCA (M2; n = 2).…”

Section: Resultsmentioning

confidence: 99%

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Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

et al. 2020

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Endovascular thrombectomy (EVT) is the preferred treatment strategy for patients with acute ischemic stroke (AIS). However, clinical outcome and prognosis in patients who undergo EVT in response to AIS with concomitant malignancy have not been fully elucidated. Data of patients with malignancy who underwent EVT at participating institutions between January 2015 and April 2019 were retrospectively analyzed. Patient characteristics, treatment methods, posttreatment strategy, and long-term prognosis were evaluated in 12 patients with prediagnoses of malignancy. Good revascularization (TICI 2b or higher) was achieved in 10 of 12 patients. Among the eight patients who survived more than 2 weeks from onset, four patients showed good clinical outcome [modified Rankin Scale (mRS) <2] at 60 days posttreatment and were able to continue treatment for malignancy. However, seven of eight patients died within a year of EVT (median survival, 83 days) due to progression of malignancy. One-year survival was achieved in only one patient whose etiology of stroke was determined as infectious endocarditis and not Trousseau syndrome. Even after successful revascularization and good short-term clinical outcome, the long-term prognosis after thrombectomy in patients with malignancy was poor. Thrombectomy for concomitant malignancy requires judicious decision, and further studies are necessary to fully elucidate its efficacy.

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“…However, the response to recanalization therapies may differ between stroke patients with and without cancer. 55,76 A recent report of thrombectomy specimens in patients with stroke and active cancer (n=16) showed that retrieved thrombi were mostly platelet-risk, suggesting the role of antiplatelet in prevention of Vol. 22 / No.…”

Section: Prevention Of Stroke In Cancer Coagulopathymentioning

confidence: 99%

Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

et al. 2020

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Systemic cancer and ischemic stroke are common conditions and two of the most frequent causes of death among the elderly. The association between cancer and stroke has been reported worldwide. Stroke causes severe disability for cancer patients, while cancer increases the risk of stroke. Moreover, cancer-related stroke is expected to increase due to advances in cancer treatment and an aging population worldwide. Because cancer and stroke share risk factors (such as smoking and obesity) and treatment of cancer can increase the risk of stroke (e.g., accelerated atherosclerosis after radiation therapy), cancer may accelerate conventional stroke mechanisms (i.e., atherosclerosis, small vessel disease, and cardiac thrombus). In addition, active cancer and chemotherapy may enhance thrombin generation causing stroke related to coagulopathy. Patients with stroke due to cancer-related coagulopathy showed the characteristics findings of etiologic work ups, D-dimer levels, and infarct patterns. In this review, we summarized the frequency of cancer-related stroke among patients with ischemic stroke, mechanisms of stroke with in cancer patients, and evaluation and treatment of cancer-related stroke. We discussed the possibility of cancer-related stroke as a stroke subtype, and presented the most recent discoveries in the pathomechanisms and treatment of stroke due to cancer-related coagulopathy.

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Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke

Cited by 47 publications

References 21 publications

Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion

Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

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